Friday, January 1, 1999

Piriformis Syndrome - A Real Pain in the Butt

by Dr. Timothy J. Maggs, © 1999

If you've ever felt pain in the hip, pain in the center of the butt or pain down the back of the leg, you are likely suffering, at least partially, with piriformis syndrome. The piriformis is a muscle which runs from your sacrum (mid-line base of spine) to the outer hip bone (trochanter). This muscle truly works overtime on anyone who runs at all.

The muscles in and around the gluteal region help with three areas
  1. rotation of the hip and leg;
  2. balance while one foot is off the ground; and
  3. stability for the pelvic region.

Needless to say, all of these characteristics are highly needed by runners.

Conclusion--the piriformis muscle is pretty important for all of us.

Injuries to the Piriformis

This muscle is a prime candidate for repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond it's level of capability, not given enough time to recover, and asked to perform again. The typical response from a muscle in this situation is to tighten, which is a defensive response of the muscle. This tightness, however, manifests itself in several ways to a runner.

The first symptom suggesting piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing a bursitis. Again, a bursitis is an inflammation of the fluid filled sac in a joint caused by an elevation of stress and tension within that joint.

The second symptom suggesting piriformis syndrome would be pain directly in the center of the buttocks. Although this is not as common as the other two symptoms, this pain can be elicited with direct compression over the belly of the buttocks area. A tight muscle is a sore muscle upon compression due to a reduced blood flow to that muscle.

The third symptom suggesting piriformis syndrome would be a sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg. The sciatic nerve runs right through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, tingling and numbness.

Simple Physiology

Any muscle repetitively used needs to have an opportunity to recover. This recovery can either be on Nature's clock, or can be facilitated and sped up with proper knowledge and treatment. Since the muscle is tightening due to overuse, continued use will only make it worse. This injured muscle needs to relax and have increased blood flow encouraged to it for more rapid healing. This tightness that exists also reduces the normal blood flow going to the muscle reducing the speed with which the muscle can recover. To encourage fresh, oxygen-rich blood to the muscle is the most powerful means of getting the muscle to begin to relax and function normally. Multiple massages per day to this area is greatly encouraged.

The next step in this "recovery" process is to use a tennis ball under the butt and hip area. While sitting down on the floor, roll away from the side of involvement and place a tennis ball just inside the outer hip bone under the butt area. As you begin to allow your weight onto the tennis ball, note areas of increased pain and soreness. Trigger points will tend to accumulate in a repetitively used muscle, and until these toxins are manually broken up and eliminated, the muscle will have an artificial ceiling with regard to flexibility potential and recovery potential. So, if it's sore and hurts while your sitting on it, you're doing a good job. Let the ball work under each spot for 15-20 seconds before moving it to another area. Once you've been on the ball for 4-5 minutes, now put the ankle of the involved leg over the knee of the non-involved leg (crossing your legs). Now place the tennis ball just inside the outer hip bone again and work the tendon of the piriformis muscle. While this pain is typically excruciating and takes some time to effectively reduce, the benefits here are huge. Be patient, be consistent and good things will happen.

Additional Treatments

Due to the fact that the sciatic neuralgia and the hip bursitis or tendonitis are both inflammatory in nature, ice, or cryotherapy, over the involved area 15-20 minutes at a time will be beneficial. This should be done multiple times per day.

Stretching of the hip muscles should not be done until the acute pain is gone. At that point in time, begin with gentle stretching, such as the cross-legged stretch while pulling up on the knee. The muscle should have increased flexibility before an active return to running.

Finally, I'm always discouraging the use of pharmaceutical anti-inflammatories. Not only do they greatly aggravate the intestines, but they also suggest an artificial wellness that can lead to bigger problems. Proteolytic enzymes, such as bromelain, are both natural and extremely beneficial with no side effects. For more information, visit your health food store or check out Rehab Plus on our website.

Until next time, remember, they can't throw dirt on you if you're moving, so keep on running.

Repetitive Motion Injuries

by Dr. Timothy J. Maggs, © 1999

After more than 75 calf pulls between 1987 and 1995, I believe I qualified as a professional patient. All of the emotional and physical setbacks that come with these life altering, or at least schedule altering, injuries for a runner were like a bad neighbor I couldn't get away from. Ironically, it was through my eyes as the patient, not as a sportsmedicine specialist, that made me truly see the void in the treatment menu available to the sick and broken.

Repetitive Motion Injuries

Repetitive motion is a term frequently heard when discussing industrial injuries. Many jobs involve the same motions with similar activities and, especially with people who aren't conditioned, injuries occur. But, when talking about athletics, specifically running, we've never heard repetitive motion spoken in the same sentence as calf pull, hamstring pull, ilio-tibial band syndrome, low back pain, plantar fascitis, patellar tendonitis, achilles tendonitis orhip pain. After living far too long as a disabled patient and desperately looking for that"glorious glass of water in the desert", I realized that all of these injuries were nothing more than repetitive motion disorders. Muscles fail to recover fully before we ask them to perform again. And when we push a muscle beyond what it is capable of doing, bad things happen. None of the specialists I contacted during my 8 year war ever suggested a solution, they could only think in terms of "after the fact" recommendations or symptomatic relief. This gross void in our sportsmedicine system reverberated loudly in my brain. I wanted to know how to keep these pulls from happening.

The Domino Effect

First of all, tightness and soreness in a muscle is a precursor to all of the conditions mentioned above. The more a muscle is used, the more it will produce and accumulate toxins and waste products. Many of these waste products localize into barrier trigger points, or nodules along a muscle fiber which prevent a muscle from generating force and functioning to full capacity. These trigger points are sore with localized pressure. Once a trigger point develops, the blood flow is reduced to the muscle, fibers in the muscle shorten and now we are forced to train or race with a muscle that's set up for a blow-out. And, should you make it through this particular race or workout, the likelihood the muscle will fully recover for your next effort is bleak at best. Ultimately, Mother Nature will win.


The Maggs Muscle Management™ Program was developed out of desperation. I couldn't accept anything less than an answer, and no one, but no one, offered any hope at all. My running consisted of a couple 3 mile runs per week. Hardly the distance needed to compete or to run a marathon.

In 1992, almost by accident, I met a muscle specialist, Dr. Andrew Bonci. He had an in-depth knowledge of muscles and injuries I hadn't heard from any of my prior experts. He showed me the importance of locating and eliminating barrier trigger points on a daily basis. Dr. Bonci explained how these toxins, which typically form in priority muscles, will ultimately force a muscle to break down if left unattended. In fact, he claimed this was the underlying cause of my calf problems. Skepticism and ecstasy shared brain space and I couldn't wait to learn which emotion would prove worthy.

Using techniques designed by him and others, coupled with stretching and nutrition, I began the long process of rehabilitating my calf muscles which had been deprived for so long of nutrient rich blood and oxygen. By using his myofascial release program, I was able to get blood to all muscles multiple times per day and significantly improve the flexibility of these muscles. There was an almost immediate awareness of benefits and improvement. I was able to work out the tightness and could feel the warmth and life come back to these oft-injured compatriots of mine.

As I began to sense improvements, I couldn't help but test the waters. I attempted my favorite 11 mile run, one I hadn't even considered for 8 years prior. Upon successful completion, it was like a religious experience. I couldn't imagine, after all these years, I was given back the opportunity to run. The joy could only be known by one who has lost something of value, only to get it back when least expected. Since then, I've been able to run 35-40 miles per week, when the schedule allows. With the knowledge and experience we've gained over the past 5 years, this program has expanded into complete warm-up techniques, thorough recovery exercises, acute injury/chronic injury treatments and performance enhancement exerices. They can all be performed alone, without the assistance of anyone else and can be done anywhere, including home, office or track.

Never again will any of us have to hear the words, "You might have to stop running", from an uninformed "specialist". You most likely are suffering with a classic repetitive motion injury. Just apply the basic myofascial release, stretching and nutritional techniques, and you, too, can get back to your life quickly and permanently. Best of luck

Low Back Syndrome - A Simple Solution to a Chronic Problem

by Dr. Timothy J. Maggs, © 1999

Statistics claim that 80% of all Americans will, at some point in their life, suffer with low back pain. For the 20% who have never experienced the likes of this, don't get too comfortable. With man evolving from a 4 legged creature at one time in our distant past to a 2 legged, 20th century, cosmopolitan athlete, no one can assume that the finger of bad luck won't point at them, especially when we add the sport of running to our activity list.

Low Back Syndrome

Low back syndrome encompasses many different conditions, but the one common thread between all of them is pain, stiffness, soreness or radiation somewhere between the mid-back and the butt. All of these symptoms suggest strongly that something is wrong. Through experience, I've learned that most runners apply the "American Dream" approach to resolving the problem; they hope the symptoms are gone by morning. Others, however, apply the "Helpful Neighbor" approach; "it's probably just (I love the word 'just') an acute spondo-hypo-lumbago-whatever, just like I had, and my doctor, who's the absolute best in the whole world, said to apply heat, relax and it will probably go away on it's own. No need to worry". Needless to say, and trust me on this one, neither of these 2 approaches offer much hope for the future of a runner. And if any other uninformed recommendations are made by the well-intentioned but clinically inept, please walk away. Please don't debate, question or discuss. Just smile, thank them and walk away.

Low Back Protocol

When suffering with any type of low back involved condition, the first step is to identify the cause of the symptoms. All peoples' backs are similar to their fingerprints; very unique. And if you never identify the uniquities of your back and spine, you'll never develop the appropriate treatment and therapy that you need to correct and improve your condition. For example, any symptoms can be a result of congenital problems (abnormalities in the back that you're born with), pathological problems (some disease process that's going on), some structural imbalance (the most likely cause) or some repetitive motion condition which causes muscles to contract and spasm causing discomfort and pain. But, you can be sure that your back pain is due to something. And, the specific cause requires a specific treatment, especially if wellness and long term correction is your objective. Most importantly, forget the"specialist" who recommends only some medication to alleviate the symptoms. This will never solve your long term problems.

Of all the tests which can be done to determine specifics with low back conditions, I rely primarily on the x-ray to give me the critical information needed. Obviously, a thorough history as well as a good physical exam will assist any practitioner in developing a working diagnosis. But, without standing x-rays of the low back, any "specialist" is shooting in the dark if they make an attempt to identify the problem.


The very first objective any practitioner should have is to rule out pathologies, or disease, as a causative agent of low back pain. I remember several years ago, I had a middle aged patient with vague low back pain enter my office. I went through the standard protocol, and after x-raying him, we learned he was suffering with an abdominal aortic aneurysm. It's the first and last time I saw an abdominal aortic aneurysm as the cause of low back pain, but due to the fact I did the correct testing, we were able to find out that he didn't belong in my office. He was in surgery within 2 days and the surgeon told him if he'd gone another 2 days without knowing this problem, he'd probably be dead. That's how important it is to know if you're dealing with a pathology or a structural problem. And if your doctor doesn't want to take x-rays of your low back and you have low back pain and haven't had them in the past few years, consider a doctor who will take them.

In most cases, however, the cause of the pain is structural in nature. With typical structural imbalances, some area of the body is always vulnerable to an increased level of stress. With the stresses of normal life coupled with the demands of running, it's not unlikely that most runners could have low back problems at some point in time. How to deal with them now becomes very important.

Once a thorough history, exam and standing x-rays have been done, it's important to have a doctor who can interpret the results and communicate them to you. Even though this sounds like a simple task, my experience is that it is few and far between who can do it all. Cherish the doctor who will make you feel confident in what he or she has found and help to manage you through both the acute and chronic phase.

Finally, a good chiropractor, osteopath who prescribes manipulation or good massage therapist is usually required to determine all of the above and correct it. For any runners who can't find the person who'll guide them through, feel free to contact me and I'll help you get the best help possible. The key is, never ever give up.

Hamstring vs. Sciatica

by Dr. Timothy J. Maggs, ©1999

One of the more difficult diagnoses to determine is that of an athlete with pain in the back of the thigh and into the buttocks. A pulled hamstring can often mimic a sciatic neuralgia, often known as sciatica. Both conditions can be debilitating and the appropriate treatment, both immediate and long term, is critical for improvement. The problem is the treatments are significantly different, so an incorrect diagnosis can delay recovery and encourage further injury.


The hamstring muscle is attached to the base of the buttocks as it attaches to the ischial tuberosity, which is that area of the butt that hurts after you've ridden your bike too much too soon. It runs down to the back of the knee. The function of the hamstring is to flex the knee, as happens during every stride when running. Every time the heel approximates the butt, the hamstring is doing it's job.

Usually, a pull will occur in one of two places--either in the belly of the muscle or at the attachment point at the top of the leg. Localized pain in either of these areas might be caused by a pulled hamstring. If activity such as walking or bending your knee increases the pain, and inactivity reduces the pain, a pulled hamstring is the likely diagnosis.

Sciatic Nerve

A pinched sciatic nerve is a completely different condition and should be addressed very specifically. The sciatic nerve is the largest nerve in the body. It originates as branches at the lower joints in the low back and it unites to form a nerve the size of your little finger. It then runs through the middle of the buttocks and down the back of the thighs to the knee. At the knee, it branches into two separate nerves--one continuing down the back of the calf and the other down the outside of the leg to the ankle.

Signals that suggest sciatica are varied. Radiating pain can originate in the lower back and run through the buttocks. The pain can continue down the back of the leg and possibly into the calf or the ankle, and it can be sharp. The straight leg raise (lay on your back and have someone else lift the involved leg, which remains straight, off the ground) will generally produce pain. A history of low back problems can also influence the onset of sciatica. There can also be tingling or weakness in the leg. If any of these symptoms are present, sciatic neuralgia is a likely diagnosis.

When you have a preliminary diagnosis, you can then take steps to alleviate the symptoms and the condition. Home treatment can be attempted initially. If improvements are too slow, however, or there are continued flareups, the need for professional help may be indicated.


With a pulled hamstring, the muscle has gone through overuse and needs to heal. Localized massage will provide significant benefit as it helps to flush the muscle and increase the blood flow, which will produce a more rapid healing. Stretching should be avoided initially. Ice should be used if there is pain and inflammation. Once the pain is reduced, moist heat might be beneficial, again to increase blood flow to the injured area. Some period of rest is needed to allow for healing. Also, if necessary, an elasticized brace or support may be indicated as well as physical therapy. Obviously, you always want to do as much as you can at home to reduce unnecessary costs. When treated at home, however, discipline is the key.

Sciatic nerve involvement is generally a little trickier to solve. Conservative, at home treatment might work if the condition is a first time condition. If the condition is chronic, professional help may be indicated. At home treatment consists of some period of rest, ice to the low back (15-20 minutes at a time, 4-5 times per day) and anti-inflammatories (all natural, if available), if necessary. The tennis ball technique under the buttocks muscles several times per day for deep specific massage is beneficial as it forces relaxation of the gluteal and hip muscles which often reduces pressure on the sciatic nerve.

The cause of sciatica can be from many different conditions, such as a low back strain, a degenerative disc, a protruding disc, piriformis syndrome, hip problems or some pathology. This is when an accurate diagnosis and professional help becomes critical.

Always find out the specific cause, and the likelihood for a more rapid recovery goes way up. Too often, we hope for the American dream ("Hopefully, the problem will be gone in the morning"). Very seldom does this treatment method work. Running is a repetitive motion and the low back, gluteal muscles and hamstring absorb much of the burden making the area prone to injury. Apply a little logic and patience and your career as a runner will last a lot longer. Good luck.

A New Revised Health Plan - Going Offensive in Your Quest

by Dr. Timothy J. Maggs, © 1999

For those tired of only doing something about your life after you've hit bottom, read on. There comes a time in life when you have to take a step back and assess your method of operation. If you're happier than anyone else you know, as healthy as you want to be and don't live from medication to medication or therapist to therapist, this article may not be for you. But for most of us, we need to read on.

New Scoring System

In this country, we have grown to believe the only time you call a doctor is when you're sick. That philosophy has extended over into our financial life as well as our legal life. I've heard most lawyers don't have wills. If this is true, it confirms my point. The reason for this is simple, most of us live life on the defensive rather than the offensive. We never address problems until they are active, real life problems. By this point, you're fighting an uphill battle and getting control of a situation becomes far more difficult.

But fight you must to get into a position of strength and offense with regard to how you run your life. Our new scoring system is not going to recommend help only when you're sick or broke or confused. It's going to talk about doing necessary exercises everyday in your life so that the cumulative effect over 50 years produces a more fulfilling life rather than one that never quite reaches a level of health, wealth or happiness.

We see health at three levels:
  1. Vibrant health is the highest level of health and should be sought by all of us. We should work hard everyday to reach this level.
  2. Declining health in the absence of symptoms is the second level.
  3. Symptomatic life (Code Blue) is the third and lowest level of health.

We need to incorporate those habits that will continually improve our health in that undying effort to get back to vibrant health and to stay there.

8 Secret Steps

  1. Nutritional Supplementation - It is time to accept that none of us will ever eat the perfect diet, so do the next best thing, supplement your diet. We all have very specific needs and there are hundreds of products out there to choose from. If confused, talk to an authority.
  2. Sleep - I consider death is the only "cure-all" that God has given us, but sleep is the closest thing to a "cure-all" while still offering us an opportunity to enjoy our future. A good 6-8 hours a night on a quality sleeping surface is a must if you hope to reach that ripe old age of 80. Nothing in life can be good after a lousy night's sleep.
  3. Exercise - Exercise should not be looked at as excitement nor should it be looked at only for vanity reasons. Exercise is the essence of life. It personifies the Pain Theory, which states that all of us will be much happier in life if we voluntarily include some level of painful activity on a daily basis so that we're better prepared for unexpected pain when it comes. It also strengthens many parts of the body and mind and gives you a good reason to feel more comfortable when drinking a post-exercise beer!
  4. Chiropractic - This has nothing to do with me being a chiropractor. I don't even practice anymore. This has to do with the fact that the nervous system is the electrical system of the body. If nerve energy has restrictions or interference in the spine, i.e. the joints of the spine become locked up, known as a subluxation, then we're going to experience some level of dysfunction. This can either be pain, tingling, numbness, weakness or reduced vitality of organs, glands, muscles, etc. Chiropractors specialize in locating and correcting these subluxations of the spine. As runners, the abuse our backs take and the joints that lock up make a good chiropractor a runner's best friend.
  5. Diet - Just because it's tough to eat a good diet doesn't mean you shouldn't continually work on it. The difficulty in eating a good diet will never cease, but the benefits are huge and well worth a gold medal effort. I try to live by the 85/15 Theory, which states that you should do the right thing 85% of the time and do what you want to do (within reason) 15% of the time. The critical part of this theory is to overwhelmingly enjoy yourself when you're cheating. If you feel guilty, you're not following this theory and if you happen to become sick, alter the ratio until you're well again. Finally, read Nancy Clark's column every month. She'll keep you on track.
  6. Attitude - you are what you think. Cheer up!
  7. Great Music and Good Humor - Listen to Livingston Taylor if you don't know what I mean.
  8. Medication - Only when the above 7 steps didn't do the trick.

Finally, remember that health and happiness takes effort. Good habits will get you there the quickest. Follow the above the best you can and you'll soon qualify as the happy man in Mark Twain's saying-- "Someday you'll meet a happy man with nothing and realize you paid too much for your whistle".

Headaches Runners Need to Know: "Why?"

by Dr. Timothy J. Maggs, © 1999

Of the many maladies runners suffer with, none should get the level of sympathy that chronic headaches command. The perfect punishment for a worst enemy, who happens to suffer with headaches, is to make them run step after pounding step for 5 miles a day, as their head explodes with each and every stride.

Many runners today suffer with both constant and intermittent headaches, and unfortunately, many doctors seem to miss the boat with regard to accurate or beneficial diagnoses. Any doctor who just writes a prescription in the absence of proper testing should----well, should be injected with headache juice and forced to run 5 miles per day.

Know the Cause

If any treatment is ever recommended for your headache without a full description of the cause of the headache, feel free to exit quickly and go to Doctor #2. Headaches can be caused by a host of problems, and to ignore the exact cause for "relief only" borders on lunacy. You must know why you have your headache before you can ever work to correct the cause. Some doctors out there forgot that "cause" matters. And for many Americans, they've never thought in terms of "cause". But, if symptomatic relief is the level your bar is at, you stand the distinct possibility of getting worse with time and finding that the level of medication you take today won't even begin to touch your pain tomorrow.

There are several common causes of headaches. Most people who suffer with headaches suffer with one or more of these conditions. You must use a doctor who is skilled in the following areas to hope for an accurate diagnosis and treatment; blood sugar, hormonal imbalances, stress and subluxations of the joints of the cervical spine (neck). Although there are more severe disease processes which can cause headaches, such as brain tumors and aneurysms, it is most common to have the more correctable causes listed above as the underlying criminal

With blood sugar and hormonal imbalances as the cause, diet plays a significant role in improving the condition. Although it is very difficult to eat a great diet these days, (a great diet consists of whole grains, seasonal vegetables, fruits, legumes and nuts), it is much easier to supplement your diet with nutritional supplementation specific for your needs. In this situation, there are dietary tests which can be given to determine what hormonal imbalances exist or what specific blood sugar problem is present. For example, blood sugar involves the liver, adrenal glands, pancreas and digestive organs. Many, many people suffer with imbalances in the blood sugar system and will never find resolution until they nutritionally balance their diets. The answer is to do as well as you can with your diet and then be willing to supplement for specific weaknesses.

If any testing is needed, a 5 hour glucose tolerance test (GTT) is the most accurate test to give the specific information needed. Most medical doctors frown on the 5 hour GTT as the only information you'll find after the 3rd hour is that your blood sugar drops significantly. This is critical information, but, if low blood sugar is found, the only effective treatment is dietary. Most M.D.'s are not trained to think nutritionally, so their interest in finding low blood sugar is minimal. A 3 hour GTT or a 2 hour post-prandial is virtually worthless unless you have diabetes.

Now, if blood sugar or hormonal imbalances aren't the cause, then think in terms of your neck and the base of the skull, especially if you've suffered with some prior neck trauma, like a whiplash injury. This area of the body has a tremendous influence over all of the body, and any misalignment or fixation of the joints at the top of the spine can pinch nerves that will cause headaches. In fact, many migraines are a result of the atlas (the top bone of the spine) being in an abnormal position. If the headache occurs over one or both eyes, think in terms of the 2nd bone, the axis, as being out of position, as there is a nerve that exits near the axis and affects this area. Any mis-alignment of that bone will produce an irritation of that nerve.


For the majority of headaches, I would recommend two providers, a nutrition oriented health care provider and a chiropractor familiar with runners. Make sure whoever you go to gives you a specific cause and treatment schedule. If it's nutritional, get an idea of what you can expect. If it's structural, make sure you can see the misalignment on the x-ray. If it's blood sugar, make sure you see the 5 hour GTT results that show a drop in blood sugar (below 70 at any point). Be careful with anyone who recommends symptomatic treatment without verification of your condition.

And last but not least, never stop searching for the answer to life. It is out there.

Herbs For Runners?

by Dr. Timothy J. Maggs, © 1999

I recently read an article in the L. A. Times about herbal products and the popularity they were gaining in this country. I've always been a proponent of nutritional therapy, and the thought that the "trend" is all of a sudden catching up with my beliefs of 20 years or more is, well, heartwarming.

According to this article, a national survey was done 2 years ago and found that 45% of Americans were aware of or had tried herbal products and 16% used them regularly. The same study, just completed, found that 70% are now aware of or have tried herbs while 40 percent use them regularly. Not only are these products gaining popularity amongst the masses, but staid medical journals recently published scientific studies on herbs and indicate the conventional medical community is also beginning to take notice.

"It's no longer a fringe movement," said Mark Blumenthal, executive director of the American Botanical Council. "Herbs are no longer folklore. People are finding out there is research to support the scientific side of it."

Herbal History

Herbs have been used by many groups and countries for many years. Authorities believe the future of herbal medicine will depend on ethical collection, organic cultivation and the protection of the natural environment. Ethical collection of wild plants was first taught by the Native Americans. Their reverence for plant life was symbolized in the prayer of gratitude offered before collection. It was their practice to only collect every third plant, knowing this would ensure a continued supply. Early medicine, in fact, used practices which today might be confused with those of herbalists or homeopaths.

Modern medicine, along with the pharmaceutical industry, grew significantly about the same time our country transformed from an agricultural nation into an industrial nation. As we entered the 1940's and 50's and farmers began moving to the cities, society accepted"artificial" in their trade for convenience in both food preparation and healthcare. The use of drugs and artificial food ingredients rose dramatically. Flavorings, colorings and preservatives were on the rise. As we entered the 60's, 70's and into the 80's, Americans began to recognize that, although they were living longer, they now led the world in degenerative disease and their quality of life was declining. Moving into the 90's with the baby boomers at the helm, they decided "enough was enough". They would have nothing to do with anything less than the best, including healthier foods and more natural medical care. Wrinkles, aches and pains once again have brought people back to herbs, and the cycle continues.

Most Popular Herbs

Now that herbs and other natural remedies have gone mainstream and are no longer the sole domain of health food purists, which are the most popular and what do they do for you?

Whole Foods Magazine recently surveyed a group of retailers and consumers to find out what the most popular herbs being sold today were:
  1. Echinacea. There are different forms of echinacea, but all of them provide relief for cold and flu symptoms. In fact, this is the third year echinacea was ranked number one.
  2. Garlic. This boasts a host of benefits, including reducing blood pressure and cholesterol and helping to prevent colds and other infectious diseases.
  3. Ginkgo Biloba. This reportedly improves circulation to the brain and lessens ringing in the ears.
  4. Goldenseal. This, too, is a popular remedy for cold and flu symptoms.
  5. Saw Palmetto. A truly interesting herb, saw palmetto has shown to dramatically improve benign prostatic hyperplasia, or enlarged prostate. This condition plagues men 40 years old and above. Traditional lore surrounding the plant also includes a prolific reputation as an aphrodisiac.
  6. Aloe. This acts as a laxative taken internally and a skin treatment externally.
  7. Ginseng. This increases resistance to stress and provides endurance energy.
  8. Cat's Claw. This reportedly boosts the immune system.
  9. Astragalus. This is supposed to have immune enhancing properties.
  10. Cayenne. This relieves pain.

The survey also found that St. John's Wort is expected by retailers to be the hottest selling herb this coming year as the media touts it as "Natures Prozac".


When all is said and done, keep in mind there are no miracles in health care. Yes, herbs can offer a better and more natural approach to wellness, but they cannot override poor health habits. Exercise, quality sleep, good nutrition and a good attitude are still necessary to ever capture all that life has to offer. As I tell my kids, "The Dirt Road" is the only way. Pay now rather than later. Herbs do offer relief of symptoms and a more natural approach, but they need to be a complement rather than a cure.

Conditioning For Our Kids

by Dr. Timothy J. Maggs, © 1999

According to a recent Runner's World article, 98% of the schoolchildren who took last year's Presidential Physical Fitness Test failed. This atrocity is due to several things; Playstation Syndrome, the computer, organized sports and misguided parents and coaches.

As a parent of 2 growing boys who love playing with Playstation, I'm continually reminded of the tight time constraints we need to keep on them. The attraction for them is so strong they'd probably go comatose while playing, forgetting that food and water were necessities for life.

The computer is the future for all of us, especially kids. If it could only be mastered while exercising, kids could kill 2 birds with one stone. But, a sedentary position is needed to compute, and the mind grows while the body GROWS.

As a coach of 4 basketball teams, grades 3-4 and 5-6, I'm keenly aware of the pros and cons of organized sports for our kids. Sure, they learn the rules of the game early on, but what they lose is so much more. School ground games were far more abundant yesteryear, and kids were able to explore their own limits and enjoyments. Today, the rigid, formalized practices and games, not to mention the intrusion of adults, minimize running and prevents kids from developing their own problem solving and communication skills. They no longer have the freedom to play hour on end using their guidelines, not society's.

Foundation For Conditioning

With the explosion of sports in today's society, sports heroes become bigger than life, and many kids want to have the success of their idols before they can even tie their shoes. They want to play a concerto without learning the scales. This delusion makes it difficult for any parent or coach to teach the fundamentals of sport and exercise. The work involved in fully educating the body, as well as the mind, requires unlimited hours of practice and conditioning. The art of delayed gratification has to be embraced by the coach and bought by the child.

This issue becomes more difficult when parents step in and push their children beyond normal limits due to the societal pressures they feel in their lives. It's often the parents who are pressuring the child to score more points and win at all costs. Too often, families leave games with the parent not speaking to the child out of frustration. This is a clear sign of misguided values.

For those kids who have the opportunity to do it right, to learn the basics and practice and train with the right intent, the road ahead gets smoother. The return on investment is grand. The victories today pale compared to the victories of tomorrow. Many people never fully grasp the value of delayed gratification and the fundamentals of exercise and life, the very building blocks that make the difference between success and failure at all levels.

Healthy Conditioning

Let kids be kids. If it's not enjoyable for them, reconsider what they're doing. Under the age of 10, activity is normal for kids. Let them fully explore motion, whether it be running, tumbling, rolling or skipping. All of these activities contribute to the full development of the nervous and muscular systems.

As all organized sports are beginning at much younger ages today, the objective should be on fundamental movement and coordination more than sport specific skills. If body motion, reflexes and coordination are improved through proper exercises that are done for a long enough period of time, sport specific skills will come much easier. Exercises like skipping, rope jumping, cartwheels, running frontward, backward, sideways and hopping are excellent for coordination and developmental skills. The consistent passing of a Nerf football over time will dramatically help any child's eye-hand coordination, hand speed, hand strength and overall reflexes without the chance for injury. As a child improves over time, shorten the distance between each of you and increase the speed of the pass. All skills will proportionately improve.

Remember, kids under the age of 15 learn at a rate dramatically quicker than older teens and adults. Don't miss this window of opportunity to teach them the very basics of exercising, reflexes and coordination. In the past 7 years, I've spent endless hours in pro locker rooms working in their strength departments, and many of the exercises mentioned above are still done by the pros. Finally, under no circumstances should weighted exercises be considered for anyone below the age of 14. Motion exercises, weight management, aerobic and anaerobic drills and joint mobility should be paramount.


The most important aspect of conditioning for kids is the individual psyche of each child. All kids are motivated by different incentives, and the exact motivation should be found for each child. Dictatorial or fear motivation should never be the chosen option when working with kids. The time should be taken to find out what moves each and every child in a positive way, and then those motivations should become the foundation for each program. Kids have a healthy yet innocent spirit to perform and we as coaches and parents should do everything possible to identify, enhance and strengthen that spirit. Our ultimate goal--don't let their spirit die.

Nutritional Support for Kids - A Necessary Compliment to Chiropractic Care

by Dr. Timothy J. Maggs, © 1999

If a patient comes into your office one day and their child is suffering with a bilateral ear infection, would you feel confident in providing treatment? Would your patient believe that your treatment was both appropriate and thorough? What if a patient comes in one day and their child is suffering terribly with allergies, has just been to the specialist and is put on high dosages of medication----would you feel confident enough to encourage your care as the primary care for this child? More importantly, would the parent feel total confidence in you and recognize that your care should be primary? And now, the true acid test---would they refer their friends' children to you?

These questions certainly provide food for thought, but they also encourage us to think beyond our own limited beliefs and philosophies. Despite how conservative or liberal we may be as practitioners, does the parent of a sick child feel thoroughly confident when the adjustment is the only treatment provided? In this world of pills, cough syrups and elixirs, is there some psychological advantage for everyone involved to support and compliment the adjustment with "more"? Is it possible for chiropractic to move up the ladder of societal respect while holding on to strict traditional philosophies? I'm sure B.J. Palmer never anticipated the tremendous growth of modern medicine and the billion dollar advertising budget used by the pharmaceutical industry today.

Regardless of what the conservative chiropractors think, parents want to give something to their sick child at home. Chiropractors need to embrace this reality. While tomorrow's generation is suffering with the sneezes, sniffles, hyperactivity, asthma and allergies today, the rigid thinking chiropractor may lose patients due to the "either/or" syndrome. "Either we have our child adjusted by the chiropractor, or we take them to the medical doctor who will give them something they can take at home." We need to make parents realize the tremendous harmony and benefits of the chiropractic adjustment with nutritional support. This produces maximum wellness and health.

Of course, the emotions vary from patient to patient. But with the inclusion of nutritional support in an effort to reduce symptoms and restore health as an adjunct to the adjustment, nothing but good can occur. The doctor will be viewed as extremely thorough in the treatment. The child's health will be supported both physically as well as chemically. And most importantly, the parent is witnessing the power of innate at work, while also satisfying their need for some form of home treatment . This comforts one of the strongest parental emotions, that of doing everything possible for their suffering child, regardless of cost.Whether the doctor agrees or disagrees with nutritional support, all parents unanimously feel better adding nutritional supplementation to their sick child's treatment program and will endorse that doctor to their friends. The doctor who only adjusts a child, even if due to philosophical reasons, is fighting the billion dollar pharmaceutical marketing industry rather than using it as an ally.

Kids and Drugs

The New York State Health Department is leading an effort to cut down on unnecessary prescriptions for antibiotics by targeting pediatricians who treat ear infections.

"The problem we see is it's over-diagnosed and it's treated excessively with inappropriate medications", said Dr. Richard Propp, medical consultant for the health department's Office of Medicaid Management. "Ear infections in children account for about a third of the visits to pediatricians and cost an estimated $5 billion annually", he said.

Statistics show that by age 7, 65 to 95 percent of all children have at least one ear infection."Yet, in treating many of these cases, antibiotics are unnecessary", Propp said. "The concern isn't only cost. Health experts worry that some infections may become resistant to antibiotics. Eight million prescriptions are written each year for this disease that shouldn't be written," Propp said.

While ear infections certainly are a common malady with kids, there are many other infectious and pathological conditions we also need to be concerned with. The flu, whooping cough, asthma, allergies, hyperactivity, hypoglycemia and digestive disorders are just a few. The only profession willing to treat this segment of the population to date has been the pediatricians. The primary treatment used are medications. This concept is the antithesis of chiropractic thinking. So why aren't we stepping up and assuming a leadership role? We need to burn our inhibitions and begin to answer the needs of our communities. If in fact we believe in what we do, we need to do it more and for all segments of the population. The truth is, there is no profession out there today better equipped to treat kids than chiropractic.

As a treating chiropractor, I know my inhibitions in the past probably had much to do with the whole psychological gap in the parent/child/doctor relationship. I lacked the confidence to assume the leadership role. I hadn't yet learned the phenomenon that parents may care more about their child than themselves. This protection mechanism and unconditionalism can only be understood by a parent. The criteria needed to treat an adult is far less strict than that needed to treat a child. The parent needs to feel their child is receiving everything possible and that the treatment is the absolute best available. If your treatment is less than that, you need to review your mission statement and upgrade your protocol.

Quality Health Needs Quality Nutrition

While more and more information is provided each and everyday on the importance of quality nutrition for kids, the reality is that the lifestyle of the 90's is almost prohibitive to good nutrition. From jammed schedules to child care centers to kids who won't eat, complete dietary requirements are not being met. The fast food industry attempts to appeal to the nutrition-conscious public with marketing, but doesn't necessarily stand up when the quality of the food is considered. Many of the fad foods marketed today are developed with just enough of the necessary ingredients or qualities to qualify them as "Fortified" or "All Natural", but the food is far from complete in providing our children with what they need for good health. All said and done, I pose two questions to all chiropractors practicing today;

1) Who is assuming responsibility for our future generations with regard to their nutritional health?

No one.

** The word "nutrition" has developed a slightly different meaning to different people. To some, it means anything that is edible and filling. To others, it means food which meets FDA guidelines. And to the most pure, it must be truly natural, organic, wild-crafted or without adulteration.

2) Which profession today has the ability to impact the health of the "next generation" more than chiropractic?

No one.

Many chiropractors prefer to avoid any nutritional counseling or consideration when it comes to their practice and their patients. That choice seems acceptable when thinking in terms of philosophical beliefs or simplification of office protocol and responsibility, but falters when thinking in terms of overall wellness of the patient. If the criteria for treatment was dictated on "What is best for the patient?", nutrition must, then, be included. Remember, nutrition is not an elective in life. We must eat to sustain ourselves and the quality of what we eat dictates our health. Kids are not eating good enough. Period. They need our help.

In a recent study performed by the Trends Research Institute, The New Millenium Chiropractor: A Trend Forecast For The Chiropractic Profession, they report "While many people have the general sense that vitamins and supplements are beneficial, even crucial, for good health, consumers lack the necessary knowledge as to what, how much and when to take it. This picture is further clouded by special interest groups, a drug dependent medical establishment, marketers and Federal agencies who offer confusing and often conflicting information. When it comes to vitamins and herbal products, today's consumer is confronted by product chaos with no single trusted source for advice." They conclude their report with, "The vast untapped market of non-users is intimidated by the volume of vitamin, supplement, herbal and mineral choices and they don't know where to go for direction. The integration of Vitamin Counseling into the standard chiropractic treatment will also enhance and increase the therapeutic effectiveness of chiropractic."

This study is far more applicable to kids than to adults as nutrition is more critical when talking in terms of children. During these formative years, or up to the age of 15, what we eat has a tremendous impact on who we are and how healthy we will become. Chiropractors are the largest natural health care providers in our country today. We should step up and assume the responsibility for the necessary education and promotion of nutritional guidance and therapy. We need to become the leaders. This should become the number one adjunct to the adjustment. This is our opportunity to educate and influence the next generation. No one else is assuming this responsibility. Just as healthy exercise should be a part of every chiropractor's dialogue, so should healthy nutrition.

With the lack of pediatric care given by our profession over the first hundred years, we have exponentially increased our task at hand. We have waited until the patient has become medically educated via the traditional medical upbringing, and then when a person moves into their late teens and early 20's, we must employ our deprogramming techniques to encourage them to embrace chiropractic care into their lives. Why don't we influence them as kids and enjoy the fruits of our labor as they grow older. This would be far less stressful and much more time and cost efficient. Chiropractic has the opportunity to be the number one health care provider in this country in the next 25 years with the ethics, beliefs and protocol that B.J. handed down, yet we sit back and ignore this opportunity. The solution for success isn't a mystery, it's just a matter of effort.

Let's take this whole concept a step further. What are the leading causes of death in this country today? Obviously, heart disease, cancer, diabetes and liver disease. There is no argument, even from the staunchest medical doctor, that our nutrition plays a significant role in the status of our health with all of these conditions. From the amount of sugar we eat, the amount of fat we take in, the artificial ingredients we consume, the drugs we survive on, etc., it's no wonder the U.S. leads the world in degenerative disease. Our diets are a tremendously important influential factor in our future health picture. So, how important is it that we get kids eating right, or at least willing to utilize a more natural approach to health than the traditional medical approach. We must be willing to step out of our comfort zones for the good of the future of this country. We need to become the true leaders in the health care profession and not stop until chiropractic is the mainstream care provided to the kids of this country.

Where to Begin

When attempting to begin the effort to become more responsible to your community with regard to the health of the kids in your community, it's necessary to know where to begin. Obviously, as a busy practitioner, none of us can begin detailed nutritional counseling to their patients. My experience is that you can spend an extraordinary amount of time with a patient attempting to improve dietary habits, but the advertising and marketing industry for fast foods and artificial foods that you're competing against will always win out. People today want quick and easy and will compromise quality for convenience. This leaves us with nutritional supplementation as "the next best thing". We must recognize that there are several basic areas we need to address with the most common kid's problems today, and if these areas can be incorporated into our treatment regime without too much distraction from our daily routines, everyone wins.

The number one area of concern with kids has to do with immune systems. From adrenal insufficiency to psychological stresses to continual contacts with other infected children, all kids are subject to ongoing and continual infections. From sniffles to sneezes to flu-like symptoms, kids will suffer. Rather than using anti-biotics as the only method of treating a child, some daily program of herbal or vitamin usage to get and keep the immune system strong would certainly be the treatment of choice. Add to that some periodic chiropractic adjustments and you now have a child with the best physical and chemical potential for life. There are many authorities out there today who believe that cancer, heart disease and AIDS are all immune deficiency conditions. Regardless of which ones are and which ones aren't, all of us would do well to strengthen our immune systems on a continual basis. And to go through our juvenile and adolescent years with immune support is critical. In fact, it's mandatory.

Secondly, parents know congestion is all too common today. It shouldn't be ignored, but the standard medicinal treatment never addresses the real cause of the problem. Some form of anti-congestive support is important when beginning a pediatric practice. There are excellent products available today which act both preventatively as well as therapeutically. Another condition, hyperactivity, is brought on by both genetic and nutritional influences and has spawned a market which has made millions and millions of dollars for drug companies. These poor kids, if left on medication alone, are mere subjects of profit. Their nervous systems are hyper-stimulated to start, and the palliative drug abuse they must live on to survive only adds fuel to a raging fire. When will the public begin to realize this atrocity?

Chiropractic care with nutritional support will provide significantly better quality care for this child, with no negative effects. Certainly, there are many other childhood conditions and illnesses that could be discussed here, but regardless of those not mentioned, most childhood conditions would be better treated if the treatment consisted first of chiropractic adjustments with nutritional support. Only after this effort proves unsuccessful should allopathic care be considered. This must become our core belief if we truly desire a leadership role.

Nutritional Supplementation For Kids

There are specific vitamins and herbs which directly promote better health for kids. It is important to have a basic understanding of the function of each and a confidence in the company manufacturing the products you're using.

Gingko Biloba: pharmaceutical studies show that Gingko can dramatically enhance the entire metabolism of the brain by improving cerebral circulation and by increasing cerebral oxygen flow and ATP production. It also stimulates peripheral circulation.

Gotu Kola: of Asian origin, this herb is used as a rejuvenating tonic for the brain. It is known as an adaptogenic tonic and acts as a restorative and relaxant for the nervous system. It also improves blood flow by strengthening arteries and veins.

Periwinkle: increases oxygen flow to the brain.

Elcampane Root: frequently employed in chronic pulmonary infections and weakness of digestive organs. It helps to bring up mucous from the respiratory system and is good for persistent coughs.

Coltsfoot: acts as an expectorant and anti-mucous agent. It is soothing to the respiratory system and has principally been used for sore throat, asthma and for coughs. The herb also contains appreciable levels of the health promoting mineral zinc.

Hyssop: has an anti-spasmodic action due to its volatile oil. It is also a relaxing expectorant.

Peppermint: has been used extensively for hundreds of years for a wide range of digestive difficulties. It is an anti-spasmodic, antiseptic and is stimulating to the digestive tract. It helps to eliminate gas, colic, stomach cramps or spasms, nausea, vomiting and headaches. Peppermint is also widely used with influenza, fever, colds, headaches and easing of nerves.

Fennel: historically used for relieving intestinal gas and colic. Gentle enough for infants. It has anti-spasmodic and calming properties.

Ginger: stimulates the salivary glands. It increases the secretion of gastric juices, aids in dispelling gases, relieves nausea, pains and cramps of stomach and bowels. Additionally, it is a warming aid for cold extremities and a traditional cold remedy. It is excellent for motion sickness too.

Valerian Root: acts as a sedative and anti-spasmodic. It has been shown to reduce nervous tension and anxiety. It also calms and relieves muscular tension while promoting restfulness and sleep.

Hops: has a sedating effect, producing improved sleep and removing restlessness. A relaxant for the central nervous system.

Passionflower: excellent herb for quieting the mind.

Mullein: acts as an anti-spasmodic, controls irritation, primarily in the upper respiratory tract. It has been shown to be beneficial with many different types of coughs and colds characterized by a mucous discharge as well as in asthma and bronchial irritations. Mullein has also been known to act as a mild diuretic.

Goldenseal: stimulates the respiratory and circulatory systems, increasing tone and power. It also assists the mucous membranes in the nose and throat and aids in decreasing gastric irritability.

Echinacea: stimulates the immune system and increase T cell count. It acts as an anti-inflammatory, anti-microbial, antiseptic and is effective against a range of viruses and bacteria. It is also traditionally used as a blood purifier.

Myrrh Gum: anti-fungal and anti-microbial effecting particularly the gums, sinuses and respiratory system disorders and gastritis. It is excellent support for the body's natural defense system.


We must accept the challenge that lies ahead. We need to escape our comfort zones and begin to proudly facilitate the implementation of chiropractic into all walks of life. We need to continue learning to provide better care and to become better teachers. The success chiropractic feels today is a direct reflection of the passion and commitment by those who came before us. Rather than reclining in our comforts, we need to push to the next level. We need to get into the schools and civic groups professing who we are and what we do. The time is now for the future of our profession. All of us agree that chiropractic is far more beneficial for the good of mankind than medicine. The key is, we must package our message so it appeals to the masses. With this approach and a continued passion for helping people, chiropractic has nowhere to go but upward.

Tim Maggs, D.C., who has been practicing Chiropractic for 20 years, is also President of Team Stick, Inc., which manufactures and distributes Hakuna MatataT Vitamins and Herbal Products for Kids. Dr. Maggs is a monthly columnist for many running magazines throughout the country. He is also the proud father of 3 boys, John, Connor and Timmy, Jr.

  1. Herbs For Children; A Manual For Parents by Sunny Pendleton Mavor, Herbalist
  2. The New Millenium Chiropractor: A Trend Forecast For The Chiropractic Profession by The Trends Research Institute
  3. Herbs of Choice by Varro Tyler, Ph.D.
  4. The Holistic Pediatrician by Dr. Kathi J. Kemper

The Pain Theory

by Dr. Timothy J. Maggs, © 1999

We live in a society that teaches us to run from pain. Pain is the enemy, and the enemy should be avoided at all costs. This type of teaching is the very basis of a weak society. But, pain is not the enemy. Weakness is the enemy, and this creates pain.

No one gets through life without experiencing pain. Pain comes in a variety of forms, and can present itself when least expected. There are physical versions, such as a broken leg or an automobile accident which leaves us injured and requiring stitches to sew up the severe cut on our face. There is emotional pain, such as the loss of a championship game. And then there is the spiritual pain, such as the death of a loved one. Regardless of the category, pain will be part of everyone's life at one time or another.

While society tells us "you haven't got time for the pain", the fact is that you'd better have time. When pain arrives, our fast paced lifestyles usually find it much easier to rid it quickly, without having to give too much thought. The problem is that pain is a symptom. Pain is a reflection. Pain is not a condition, it is a result. At some point in time, we must do the necessary due diligence to identify the cause and work on a correction. The price that is paid for a correction always costs more if we ignore all warning signals. Our society almost encourages us to wait, as our pains, if not addressed, will ultimately produce profits for others.

Pain must be viewed as a disciplined coach who is teaching growth, strength, happiness and success. And true success is never achieved without dedication and failures, of which pain is naturally a part.

With maturity and wisdom, you will realize that pain is inevitable. Growth is needed to reach new levels in life and no growth can come without pain. Tolerating pain and using it as a catalyst to greater achievements ensures success. The key to ultimate happiness is to voluntarily subject ourselves to some form of pain on a daily basis, such as exercise or sacrificing. This will prepare you for the pains that life will send when least expected. Never again run from pain, as the artificial elimination of pain will produce permanent pain.

If you ever want to elevate your happiness, voluntarily subject yourself to an increased level of pain for a prolonged period of time and then come back to your original state. You'll be amazed how you're automatically happier.

The Seventeen Mile Theory

by Dr. Timothy J. Maggs, © 1999

"Live that you wouldn't be ashamed to sell the family parrot to the town gossip." - Will Rogers

Running is the ultimate metaphor. Our few victories and many defeats in life (or at least that's the way it feels) are more easily understood when compared with some aspect of running.
More training equals better racing.
Simple, but forgotten in the real world when we're not willing to pay our dues.
Once we cross the finish line, that was "Last Race", regardless of how good or bad we did.
This is a version of "Don't cry over spilled milk", of which all of us need continual reminding.
Snowy and icy conditions (Problems) add to the exhilaration of a run, once completed.
This is unheard of in real life. Problems equate to stress, not exhilaration.

Running creates philosophers and mileage produces theories. Thus, my "Seventeen Mile Theory".

It was a beautiful Spring Sunday morning for the Troy Marathon in New York. Troy is a great representation of upstate New York as it has significant history and tradition associated with it. Like a true warrior, Troy has survived the economic difficulties of the great Northeast. A marathon in Troy was only appropriate.

So it was until we reached the 16 and a half mile mark. I felt reasonably good to this point. Keep in mind my "feeling good" had nothing to do with a state record or race victory. My only stress was to finish. No more, no less. That was enough challenge for me as I'd hate the thought of having to "race" a marathon. As I approached the 17 mile mark, stress #2 became more and more obvious. Typically, the 4 times I go to the bathroom before a marathon covers any interruptions that might occur during a race. Not so today.

By 17 miles, there were no options. Go or die. The decision was quick. Go, and don't look back. Unfortunately, the "go" happened to be on the steps of city hall in the heart of downtown. Stop, quick, over. Simple.

Until later.

How on earth could I have made a decision to defecate on the steps of city hall on a Sunday morning, and think nothing of it? It seemed so right at the time, but after the race, I felt like going to confession or doing community service or something. I just couldn't imagine....

In looking back, the perceived gravity of the situation became enough for me to create another of my many theories. I learned about the act of judging others and drawing conclusions based on minimal information. If I were to judge "me" in the court of law that was prosecuting me for indecent exposure and defecating on the steps of City Hall on a beautiful Sunday morning, I'd probably be the first to say, "Hang him!". But, it was me. I was the defendant. Most wouldn't understand. I had to go. There were no options. There must be some clause in the law to protect public defecation. I would have exploded and never finished the race. And I had to finish the race.

Years after the incident, it's all but forgotten. But, the reality remains. I committed the "crime" and could have been doomed for life by the jury (the 80% of society who have opinions on everything). Everyday in the paper, someone new is taken down by the media for some skeleton in their closet. I shudder with the thought that some newspaper reporter happened to be there catching me on film. My claim to fame in the public eye for evermore would have been that I had a bowel movement on the steps of City Hall in Troy, New York. On a Sunday morning, no less. That's how people identify you for years and years. If it's in the paper or on the news, it's real and becomes you. Forget all the other good you've done."Hey, there's Tim Maggs, the public defecator!" Ouch.

This type of story becomes coffee break material from coast to coast. As long as it's someone else's head in the guillotine, they talk about it all day. Even though all the facts are unclear or not available, they still judge and talk as though they know because that makes their life seem a little less crummy I guess.

My ultimate "philosophy" is nothing more than a feeble attempt to encourage all of us to not judge. If you don't know the facts, don't give an opinion. If you weren't there, leave it for the higher sources. As all of us hate to have someone talk about us unknowingly, we too should avoid such pitfalls. And most really don't care what your opinion is anyway. They want you to hear theirs, as if they have some higher source of wisdom.

I recently spent time doing a tour on grand jury. The top assistant D.A. was asked if he felt O.J. was guilty. More than most of us, he should have had a legitimate legal opinion being that he understood the law better than most. "I didn't hear all of the testimony, so I don't have an opinion." God bless him.

Keep running and creating your own theories and leave the judgment to those wiser than us. I'm not quite sure, but somehow this relates to sportsmedicine.

Winning the Mind Game

by Dr. Timothy J. Maggs, © 1999

The only real security a man can have in this world is a reserve of knowledge, experience and ability. - Henry Ford

The man who knows the combination to a lock has a far greater chance of entering a locked door than the man who doesn't know the combination. Equally as valuable as knowledge is wisdom and mental toughness. Most of us are not born with these two qualities. They must be learned and earned. And you can rest assured, the price isn't cheap.

We all know the formula for developing physical strength---hard work. Regardless of the many reasons why you can't train, you know that the only way to get strong is to train. Sickness, fatigue, obstacles, mood swings, equipment breakdowns. There are so many excuses why you shouldn't exercise, it's amazing any of us do. But, the one clear and obvious reality is that people exercise all around the world. Day in and day out. Take Bill Cuculic from Tucson, Arizona. As of January 1, 1999, Bill has run 5,540 consecutive days without missing a one. A total of 43,102 miles, or a daily average of 7.78 miles per day. Bill must not know the many excuses which could easily buy him some time off.

The mind game has to be played with the tenacity of a Bill Cuculic. There is no room for weakening. There are no obstacles, regardless of what the apparent obstacles look like. We must win. We must prevail and not give in to the opponent. No matter how weak we feel or how tough the going gets, "right, left" must continue. As Uncle Bill always quipped, "It's a great life if you don't weaken".

What is winning? Who is our opponent? And what trophy do we ultimately win?

Mental Victory

The prize for winning the mental game of life is simply happiness. Being at peace with yourself. Being where you want to be in life. Being with the person you want to be with. Being happy. Reaching your dreams. Believing your dreams still exist.

For too many, however, dreams are merely bad memories of the good times when you thought life was good. Life has become nothing but a day in and day out struggle with no hope in sight. Winning the mind game isn't even a possibility. The game is over as far as they're concerned. Once you've quit the game, winning becomes futile. But, if you can just stay in the game, give it just one more shot, one more step in the right direction, pretending like you knew all along you could do it, you might be amazed at the outcome.

After all, everything in life is mental. If you think you look good, you look good. If you thing you're wealthy, you're wealthy. If you think it's a beautiful day out, you're right. So why can't more and more people realize it all begins in the mind. Why are so many willing to physically train their little hearts out, but mentally, there's an epidemic out there of weakness and breakdown? Why?

Mental Strength Traits
  • Focus-the ability to see clearly regardless of the pain.
  • Discipline-the ability to stay the course regardless of the obstacles.
  • Preparation-the only way to succeed.
  • Perception-seeing life in a way that will keep you motivated towards your goal.
  • Persistence-the ability to get it right. It may take 100 times, but....
  • Mind Control-to not succumb to distractions, obstacles or problems.
  • Momentum-momentum breeds momentum. When down, take action!
  • Success Belief-having a stronger belief in your success than the cumulative effect of the negative forces in your path.

Mental Exercises

"It wasn't my successes that helped me grow, but the obstacles I overcame". - John Kluge, Billionaire

Action/Reaction Theory

The key to success in life is to ACT, not REACT. We spend most of our days reacting to what happens around us. Create a plan and let the world react to you. Don't go off course too easily.

Next Bite Theory

The only bite you can truly enjoy is the one that's in your mouth, yet we spend our time looking at the plate determining what our next bite will be. Learn to enjoy "this bite" in every aspect of your life. This requires continual practice to become good at it.

Comfort Theory

Most people continually seek comfort. Comfort creates weakness while difficulties create strength. Seek difficulties and recognize comfort. Learn to live out of your comfort zone.

Commitment Theory

As Zig Ziglar says, "It isn't what you get by reaching your goal, it's what you become by reaching your goal". Many people break before they reach their ultimate goals because of weakness. Commit! Your life will only get better and when you reach your goal, you'll love the person you've become.

The Cycle Theory

The normal flow of life is to have ups and downs. Rejoice the ups and stay there as long as you can, but recognize the lows are normal. Don't treat them like a disease, as that behavior keeps you down.

The Shelf Theory

Picture each and every problem you have in a separate box on a shelf. People can only handle one problem at a time, so grab one box at a time when you're going to problem solve, focus completely on that particular problem and put it back when you are done. This will create efficient and uninterrupted problem solving. When your problems are organized in boxes on the shelf, your mind is free to enjoy life.

The bottom line----be happy!

The 25 Mile Theory

by Dr. Timothy J. Maggs, © 1999

"Never been so close, never hurt so bad".

Once again, the similarities between running and life. More people are starting to "get it". Running is life. If you can get to know running, you'll get to know life.

My wife, Trudy, and I, proud parents of two boys, recently learned she was pregnant. Although we were excited at the sight of that tiny heart beating on the ultra-sound, Trudy felt a wave of concern as her last two pregnancies ended in miscarriages. We took this opportunity to discuss the varying perceptions she and I had in looking at this situation. Was this good news, or just another situation we'd have to brace ourselves for if the bad news arrived? As with any "issues" 2 people go through together, it's always interesting to compare the difference in perceptions and feelings. I was thrilled at the thought of becoming a father again. Trudy was cautious.

The Marathon

With most experiences in life, my brain defaults to the marathon. It's life's simplest deal. Continue and you win. Stop and you lose. The popularity of the marathon over the past 15 years is a clear indicator that the masses have caught on. People have learned that the least gifted person can now be a finisher in a marathon. The Achilles Track Club has stories crazier than Ripley's Believe it or Not. But, the common denominator is that when the spirit is strong enough, when the desire is juiced, any mountain becomes the victim. "Every mountain looks so high when you're standing at the bottom, but when you've made it to the top, you can't see the problem". Paul Overstreet. Perfect.

So, the whole deal is that at the 25 mile mark in a race, if you're not committed, if you doubt your abilities, if you question whether there's a God or not, or lose faith, confidence and belief in the order of the universe, you may find the burden too heavy and quitting becomes your option of choice. You see only the pain and fear of continuing. People too often base decisions on how they feel at the moment, ignoring the bigger, more spiritual landscape that offers unlimited potential and lies out there in the universe. They quit marriages, jobs, exercise and a host of other challenges, all because it hurts. They accept defeat.

This theory, however, clearly states that we will all meet the "25 mile mark" many times in our lives, and although it hurts in the worst way, the only way to the finish line is to get through it. The option to quit is always available, but now you must go back to the starting line and once again get to the 25 mile mark in order to ever get to the finish line. And the rules never change. If you continue, you win. Stop, and you lose. So simple.

Hard Lessons - Simple Solutions

I've been working closely with a father of a young and talented hockey player who has suffered for the past year with a chronic groin injury. He's been to many, many doctors, therapists and coaches who have desperately tried to help. His hopes have been raised many times, always ending with minimal or no improvement in his condition. He is devastated psychologically. He refuses to see anyone else as the fear of raised hopes hurts too much. His youthful psyche hasn't matured enough to allow him to understand the 25 mile theory. He doesn't realize the only way he can reach the finish line is to, once again, go through that 25 mile mark. He must learn from the past and approach his future with youthful optimism. He must learn there are no problems in life, only solutions. But, sometimes they're hidden pretty well. Remember, continue, you win. Stop, you lose.

So, as Trudy and I reflected on our thoughts and emotions after learning of the pregnancy, we quickly ended up at the 25 mile mark. Never been so close, never hurt so bad. But, the only way to enter that delivery room some 9 months away was to first see that little heart beating on the ultra-sound. And although the possibility of another miscarriage is always very real, the only possibility of a healthy, happy baby is to become pregnant.

The key to it all is to develop a positive and healthy thought process that will complement your successes rather than contribute to your failures. The marathon and the many lessons learned through participation is the perfect guide book to help all of us get through the griefs of life. Every experience can be simplified and appreciated. So, win or lose, the ultimate benefits come with marathon wisdom.

Conditioning in the Pro Locker Room Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 1999

(This is the second in a series of articles co-authored by Dr. Tim Maggs and Coach Al Miller,
Head Strength and Conditioning Coach for the Atlanta Falcons.)

For years, Chiropractic has been trying to create and take possession of a niche within the sports world. Although years of research and success stories overwhelmingly prove the benefits of Chiropractic treatment for athletes, individual Chiropractors haven't always faired as well when attempting to become part of organized sports teams. Organizational politics and professional biases will always contribute to preventing the "new kid on the block" from entering the sanctity of a pro or college locker room.

In order for Chiropractic to enter this arena and carve out the much desired turf amongst the other professionals working for a team, there must be a professionalism and consistency in the protocol brought to a program. There must be a bigger purpose other than to relieve pain. The massage therapist can relieve pain. The physical therapist can relieve pain. The medical doctor can relieve pain. Stealing their precious turf in the locker room is virtually impossible. But, to become the biomechanics specialist with an iron clad protocol that is easily understood by all will lead Chiropractors to a corner in the locker room which is uninhabited. That is, until players, coaches and medical personnel begin to understand and appreciate the value and benefits of detecting and correcting biomechanical faults.

Ally of Strength and Conditioning Department

Strength and Conditioning Departments are highly concerned with all physical, biomechanical and structural information on an athlete, however, are unable to perform, interpret and provide the same testing and treatment that Chiropractors are skilled at providing. This relationship thus becomes the most important relationship for all Chiropractors interested in working with teams. As discussed in last months article, the Strength Coach and the Chiropractor should work hand in hand in reviewing each others evaluation of an athlete and the rehabilitative program should be cooperatively understood for the long term benefits of the athlete.

Chiropractic Rehab Program

True Chiropractic rehabilitative care can only begin with the absence of symptoms. If symptoms brought the athlete in for care, then symptoms need to be resolved prior to any rehab program.

Objective findings can come from multiple sources. One of the more valued objective structural tests available to the Chiropractor is that of the standing x-ray. There are many marking systems which show if an athlete is structurally aligned and balanced. Structural defects, or imbalances, include pelvic rotations, subluxations (locked joints), increased or decreased curves and narrowing or swelling of the disc spaces.

Some of the more popular markings used to show structural status are the gravity line, as seen on the lateral L-S view, dropped from the center of the body of L3, straight down. This gravity line should bisect the anterior third of the sacral base. If the line is anterior or posterior to this point, weight is being handled by parts of the spine not designed to handle the weight, and eventual problems are predictable. A second marking is that of the sacral base angle, which is normally 36°-42°. An angle greater or lesser will suggest a pelvic angle inconsistent with normal positioning of the pelvis, thus producing a work load which will not be tolerated well. These findings become compounded with the introduction of any athletic activity and are key references when setting up a rehab program.

The length of care and treatment in setting up a rehab program will be influenced by many factors. Typically, the age and health of the athlete are the two most important criteria, but the degree of structural defect usually dictates the amount of time needed for maximum improvement. Frequency of treatments and specifics of treatment provided will vary from doctor to doctor, technique to technique and patient to patient. A successful time frame for most rehab programs dealing with spinal rehabilitation will take anywhere from 3-6 months. The ultimate goal is to have objective improvements on a final re-examination, which will include re-x-rays, as well as any other contributing tests which were initially performed.

During this 3-6 month period, proper treatments and therapies are provided. Improved habits are taught. The integration of rehabilitative exercise and conditioning will provide the maximum potential benefits to all patients. Working with a strength coach, or physical personal trainer, will enhance Chiropractic rehabiltative care. This program can also include nutrional support and positive psychological training. But, the critical component here is time, and if a Chiropractor cannot communicate to and manage the patient for a long enough period of time, the likelihood of success is reduced greatly.

Strength and Conditioning Program

Also discussed in last month's article was The Pyramid System (Fig. 1), which is a conditioning program designed by Coach Al Vermeil, Head Strength and Conditioning Coach of the Chicago Bulls. This system is the backbone of the conditioning program for the Chicago Bulls and Atlanta Falcons.

The Pyramid System

The Pyramid System is a calculated individualized approach which brings each athlete along at a rate they are capable of handling. The desired goal for everyone involved is to push an athlete through a conditioning program as hastily as possible, but never at a pace that will produce injuries.

Work Capacity-1st Phase

Keep in mind that the best players in almost all sports are your fastest and most explosive athletes. The lower the conditioning level of an athlete, the more time they need to spend in the work capacity phase.

In this phase, there are many different types of exercises done. Medicine balls are used for abs and total body work. These can also be used with tempo runs. For example, an athlete can do 100 yards of underhand/overhand throw with 6 kilos, 10 kilos and 15 kilos. Once they reach 100 yards, they'll run 200 yards of tempo work, come back, throw it 100 yards and walk to the ball. Other exercises used could also be teeter boards for the lower body and physio balls for the upper body. All of these exercises are very important in preparing the body for overhead lifting.

The Work Capacity phase of the Pyramid System, for the most part, is done without the use of added weights to an athlete's program. There are six sub-categories, and each one provides immeasurable benefits in the final quest to get and keep an athlete conditioned. No athlete should go to the second phase of conditioning (Strength) until they are fully capable of performing all six sub-categories of Work Capacity.
  1. Anaerobic Capacity-In basketball, the furthest distance you can run is 90 feet. In football, the furthest you'd ever run at one time is 110 yards. Anaerobic capacity is the athlete's ability to explode for periods of 5-6 seconds at a time with rapid recovery. This type of conditioning requires serious training, as the body's oxygen utilization system must dramatically improve as well as the recovery ability of the athlete. The athlete will ultimately need to perform the same task 10-15 times with a rest of about 40 seconds, which is the same as the time clock in football.
  2. Body Composition-Today, there are extremely sophisticated means of detecting body fat that can come within a half-point of accuracy, plus or minus. Depending on the sport and position the athlete plays, the ideal body composition is critical for success of that athlete. The program is designed to help the athlete reach close to ideal body weight and composition before moving on to the second phase of the Pyramid.
  3.  Joint Mobility-as Chiropractors have known for years, full and unrestricted joint mobility is critical for maximum performance and ultimate prevention of injuries. Joint mobility is influenced by the tendons of a muscle, the tension of supportive muscles, surrounding ligaments and biomechanical defects of an athlete. This area is especially important for Strength Coach and Chiropractor to work together on. For example, an increased sacral base angle will alter an athlete's ability to either flex or extend at the hips and waist. Without the knowledge and correction of this structural defect, an athlete may be pushed beyond what he's capable of handling.
  4. Strength Endurance-This category works hand in hand with Anaerobic Capacity. This is an athlete's ability to apply a given force time and again, play after play for 50-70 plays per game. The strength aspect is recognized by an athlete's ability to show absolute strength, or the ability to exert force without the equation of time being a factor.
  5. Core Strength-This is one of the most important categories in the Pyramid. Core strength refers to abdominal strength. This ranges all the way up to the thoracic cavity and down to the pubic crest. Core strength is critical for full body stabilization. If a body can't stabilize, an athlete will have a difficult time exerting force into the ground while moving fast. This will translate into an inability to take on blockers or playing against other players. This also requires strong low back muscles, such as the gluteals, lumbar erector spinae group and other pelvic muscles. This area of development is critical as it is one of the strongest parts of the body and the strength here will permeate out to the rest of the body.  Much abdominal work is done either on the floor or on physio balls. There is also an ab bench that is used, both with and without weights. The lumbar area is initially worked by performing hyperextensions without weights, or with pauses. This must be mastered before an athlete can ever add weights on their backs or over their heads.
  6. Aerobic Capacity-this categoy is usually acquired if the anaerobic capacity is done correctly. For athletes such as football players, too much distance work should never be done, as that will retard both strength and speed.

Strength-2nd Phase

Once an athlete shows they can actively demonstrate running tempo runs, have improved core strength, good joint mobility, improved body composition, aerobic and anaerobic skills and are going through the warm-up series efficiently, they are now ready and able to go onto the next phase, the strength phase. This phase also continues to help body composition. Joint mobility is critical now as the athlete has to be able to perform movements with added weight. As discussed earlier, if an athlete has restricted movement without additional weights, problems will occur once weight training is added to the program. There are 3 sub-categories in the strength phase.
  1. Maximum/Relative-Maximum is just what it says, the maximum amount of weight an athlete can press or squat. Relative is the amount of weight an athlete can lift relative to body weight. The ratio governs the amount of weight best tolerated by the athlete's height and weight. This ratio, along with the position a player plays, will determine the amount of weight used in strength training. It's important to make sure a player can power clean or snatch a certain percentage of their body weight and it helps to set up maximums without having to test the athlete. A 185 pound receiver certainly shouldn't lift the same as a 300 pound lineman or a 250 pound linebacker.
  2. Eccentric Strength-Occurs often, especially when an athlete has to decelerate and perform quickly. This is done when an athlete has to stop quickly, change directions and load new muscles. Many athletes can fluidly move, but when asked to stop and load new muscles, many of their unseen problems become magnified, such as joint problems (i.e. hips, knees, feet, ankles). Using certain rhythms in weight training is important. Ideally, an athlete should come down slowly with weights and go up with explosion.
  3. Static Strength-Again, this can only occur after work capacity has been achieved. This is the strength needed to assume and maintain a position for some period of time. Examples would be a batter in a stance, a lineman holding a 3 point position, etc.

Strength Speed/Speed Strength-3rd Phase

This is the phase an athlete will enter after completing the first two phases of the pyramid. Strength speed is basically your Olympic lifts, while speed strength is your plyometric movements, your bounding, your uphill work and similar exercises. Appropriate exercises are recommended to athletes based on their need for increased speed or increased strength. The important issue here is that a proper progression must be utilized to give the central nervous system adequate time to become educated.
  1. Starting Strength-this is the amount of force you can generate from a stopped position, overcoming the inertia of the bar.
  2. Explosive Strength-this addresses the rate of force development. With specific exercises, the speed of an athlete's explosiveness improves, which is a reflection of the speed and time needed for a muscle to attain maximum strength during a specific movement.
  3. Reactive or Elastic Strength-movement where there is a rapid decelerization followed by a small amortization period followed by a very strong concentric contraction. An example of this is the depth jump.

Speed-4th Phase

Simply put, speed is the moving of the body through a range of motions, both arms and legs, in the fastest times. As stated earlier, the best athletes in all sports are typically those with the best speed.

Speed without strength will prevent an athlete from ever reaching full potential. The Olympic lift is mandatory for an athlete to gain complete strength. Other important factors consist of joint mobility, body composition and core strength, just to name a few. Ultimate speed is the culmination of all the ingredients which make up the pyramid. There are 3 sub-categories in the speed phase.
  1. Acceleration-This is the most important ingredient in sports. This covers 0-about 45 yards.
  2. Absolute Speed-This is the speed that takes over after the 45 yard mark.
  3. Specific Speed-This refers to each particular sports pattern which has to be accomplished within a particular position. Every position needs different requirements. There may be similar movements, but no two positions have identical movements. Offensive guards pull and take angles, where defensive linemen don't. Wide receivers run a lot longer distances than an offensive lineman. A defensive back always starts out running backwards. A quarterback is going to run while looking over a shoulder. Linebackers can run either forward, lateral or backward. Running backs are like catching ricochet rabbit. And the tight ends are a combination of all the above. There is no one way to increase speed for all players, but there are common factors to impove speed for all positions.


Regardless of which protocol you refer to, whether it be a thorough consultation, examination, report of findings and corrective biomechanical program by a Chiropractor, or a thorough assessment and management of an athlete through the pyramid and throughout the season by a Strength Coach, the end result is only as good as the detail of the work done.

The benefit to the athlete improves greatly if both Chiropractor and Strength Coach go the extra mile to employ thorough management of the athlete. This benefit further improves if full and continued communication takes place.

Those Chiropractors interested in sports and working in the locker rooms throughout the country have to become more involved with the details of the athletes biomechanics and the objective improvements which can be made. They need to develop close working relationships with other members of organized sports teams, especially the strength coaches throughout the country.

And with every opportunity, continued biomechanical education needs to be provided to the athletes of all sports. Only with hard work and a committed effort by all will Chiropractic one day become that biomechanics authority in the pro locker room.

Conditioning Pyramid

Raising Chiropractic's Value in Pro Sports Through Vision, Management and Communication

by Dr. Tim Maggs and Coach Al Miller © 1999

(This is the first in a series of three articles by Dr. Maggs and Coach Miller for Chiropractic Products Magazine)

Chiropractic has gained significant visibility and popularity in all sports in the past 10 years. Coaches and athletes are now beginning to appreciate the importance of biomechanics, balance and full motion in all joints of an athlete. After all, keeping players well is the sole objective of a team's medical staff.

Most chiropractic benefits seen to date actually pale next to the true potential chiropractic has to offer all sports. Under the assumption that no other professional is as well equipped as the chiropractor to evaluate, diagnose and treat the biomechanics of an athlete, the time is now for chiropractors to envision their role as an authority in the locker room. A qualified chiropractic protocol needs to be established as well as the development of cooperative relationships with other members of the medical staff working for the team. That necessary protocol consists of a plan of treatment originating from a thorough pre-season evaluation, including history, examination and necessary standing x-rays. This is followed with a report clearly communicated to the athlete outlining what recommendations and treatment will be required to make objective biomechanical improvements during the course of the season and then the management of that athlete throughout the season. Although this requires tremendous confidence and managerial skills, this is the role now available to the chiropractor in the locker room. This is a far more comprehensive approach to treating the athlete than simple symptomatic treatment when an athlete feels the need to be adjusted. In order for chiropractic to gain the respect it deserves, it must prepare itself to become the biomechanics authority it claims to be.

Once a thorough history and exam is completed on the athlete, the chiropractor must then develop a program in conjunction with the strength and conditioning department so that all personnel involved in the conditioning and treatment of this athlete are working towards the same short term and long term goals for the athlete.

Newer Heights and Higher Visions

While chiropractic is by far the most qualified profession to locate biomechanical faults and correct them, many sports chiropractors have fallen victim to providing treatment based only on symptoms, thus competing with all allopathic counterparts. Although we tend to still see ourselves as treating the cause of the problem, in truth we are merely treating "the pains", but using chiropractic manipulation as the medicine.

Many pro teams have chiropractors on staff to provide manipulation to players. Players, however, often are the ones who decide when and how frequently treatment is needed. While this involvement in the locker room is truly a success for chiropractic to be included with the trainer, physical therapist, orthopedist, dentist, massage therapist and a host of other professionals, this limited role should never be accepted as the ultimate objective. Chiropractic is capable of offering so much more. And if the profession can fully grasp their potential as the biomechanical experts in the arena of the pro locker room, they can then take that protocol to the colleges, high schools, grade schools and mass market. Every athlete wants the very best care they can get, and chiropractic has an opportunity to be a primary contributor to that care.

To gain this recognition and respect, chiropractors first must elevate their protocol to help the athlete attain higher levels of success. The athlete should never be the one determining frequency of treatment. All treatment considerations should be based on history, examination and appropriate standing x-rays. Once x-rays are marked and all information is reviewed, a season plan needs to be structured for that player for the coming year. Many chiropractors are unable to manage an athlete through 3-6 months worth of acute care, rehab and conditioning care. These shortfalls will prevent the profession from gaining the level of respect desired. But, if the profession can adapt a protocol which promotes management of the athlete through objective changes in biomechanics as well as improved communications with the staff and athlete, chiropractic will succeed in a large way in the sports world.

Joining Forces

In the pro locker room, as well as colleges and many high schools, the strength and conditioning department is in charge of assessing all players in pre-season with periodic evaluations throughout the season. The strength coach is then responsible for determining what pace an athlete can become conditioned and the specific conditioning program appropriate for each athlete. The ultimate key to success is based on the coaches ability to manage that player before and during the season. A successful Strength Coach provides those exercises which help educate an athlete's nervous system. A successful Chiropractor locates and removes interference to that athlete's nervous system. Working hand in hand is critical.

Chiropractic must couple their efforts with the strength and conditioning coach for the good of the athlete. Both parties have tremendous interest in the biomechanics, joint motion, balance and skills of the player, and some of the testing is identical. But, both parties also provide totally diverse biomechanical benefits to the athlete, and joining forces will help create an exponentialism of benefits for both athlete and team.

Chiropractic Athlete/Patient History

The chiropractic history must not only focus on the present list of symptoms or injuries, but should also consider prior injuries. Keeping in mind that chiropractic has been very limited to many athletes currently involved in sports, the likelihood is strong that prior injuries, especially those to the spine, are still evident through limitations in the normal range of motion and creates an increased vulnerability to re-injury. Secondly, much of the chiropractic care given may have been symptom based care, and the actual fixations and restrictions of certain joints may still exist.

Chiropractic Exam

Balance, range of motion and symmetry are key issues when performing an athletic exam. If current standing x-rays have not been taken or are not available, new x-rays should be taken of the cervical spine, the lumbo-sacral spine and pelvis. Hip joints should always be included. Detecting positive objective structural findings, both on the exam and x-rays, is critical in motivating and educating the athlete to participate in a complete corrective care program. Without objective findings, it becomes much harder to convince an athlete of the benefits of complete chiropractic care.

Assessment in the Strength and Conditioning Department

When a new player comes to the team, one of the first things done is to review his medical jacket, which is a log of all prior injuries and treatments. Most players have gone through the Indianapolis Combine, which provides significant physical information on the player. When prior injuries exist, an in-depth history will then be taken by both the trainer and strength coach. A former strength coach may be contacted by the new team to determine what a player can and can't do. The player is then asked what he can do, what he feels comfortable doing and exactly what his psyche is with any existing injury.

At this point, a visual physical exam takes place, checking out the shoulders, the hips, the alignment of the spine, the gait as they walk to and from, the foot placement as they run and move and the entire kinesthetic circle of movement. Very little, if any, weighted movement will be done in the first week.

Balance and strength are critical components of an athlete's conditioning. One legged squats are used to check for both, while also determining ankle and knee flexibility. Football, for example, is a one legged game, and without one legged strength, a player will never make it. These two areas are further tested with a teeter board squat, or a prisoner's squat, which is a series of squats with the athlete's hands behind their head and then in front of them. This immediately tells the flexibility or inflexibility of a players hips. In the game of football, if hips are tight and restricted, a players movement will be severely compromised, especially, a defensive back, wide receiver or running back. Tight hips also hinders the explosive ability of an offensive or defensive lineman. Finally, with the teeter squat, if a player teeters one way or the other, restrictions or pains in one or both ankles should be considered.

A player is then asked to perform a solid hold for one minute on the low back hyperextension machine. This will check for strength in the low back, hips and hamstrings. It's important to watch a player during this exercise as weaknesses produce deviations during the exercise. One minute is a reasonable time to quickly assess the strength of an athlete.

Psychological Evaluation

During any evaluation process, both physical and psychological are looked at very closely. If an athlete can't perform specific exercises, but has a tremendous amount of "want to", they are termed a medical reject. On the other hand, a player who can perform but is unwilling to is a much more serious problem. This is the infestation of "don't want to work attitude".Sports is a working business. You must have athletes who are willing to work at all times and improve.

Chiropractic Report of Findings

In a report of findings, athletes tend to want to know how to get rid of pain so they can quickly get back. Although pain is important and current injuries must be of primary concern, long term structural improvements should always be the ultimate goal for the athlete. The first objective is to "put out the fire". Immediate reduction of symptoms, through treatment, physical therapy, ice/heat, nutritional supplementation or medication, restriction of activity and whatever other recommendations are needed should be implemented first. This period can last anywhere from one to eight weeks. However, once reduced, structural improvements should then become the primary concern. This is where chiropractors can begin to separate themselves from the rest of the medical staff and improve their relationship with the strength and conditioning departments. Management and communication skills become paramount.

The second phase of care, "rehabilitation", should take all positive objective findings and develop a program that will help turn those positive findings into negative findings. A positive Lasegue's, for example, will most often be eliminated once the first phase of care is completed. A severely increased sacral-base angle, however, as seen on a lateral L-S x-ray, takes a committed effort on both the athlete's and doctor's parts, and can only improve with proper treatment and exercise over a long enough period of time. This phase can last anywhere from 3-6 additional months, and re-x-rays should become a key component to determining what changes have taken place. Depending upon the degree of structural defects and the number of prior x-rays an athlete has had, at least one and maybe two sets of re-x-rays will be appropriate during and after this phase of care.

The final phase of care consists of whatever treatment and conditioning is needed to maintain the level of wellness which has been reached. With the work and effort that was put into the first two phases of care, it's important for an athlete to protect that investment and do whatever is necessary to maintain it. Frequency of chiropractic treatment will vary case to case, but will typically be a varying frequency. The benefits from a full rehabilitative program consist of less chance of re-injury or any new injury, a quicker recovery from injury and a greater ability to perform on a functional level.

Strength and Conditioning Program

Every athlete is like their own fingerprint. Recognition of weaknesses and strengths will greatly help in setting up a quality strength and conditioning program. A very successful program, working on order of development, was put together by Coach Al Vermeil, Head Strength Coach of the Chicago Bulls. This system works from a pyramid (Fig. 1), and begins at the base with Work Capacity. A sub-heading under this group is Body Composition. Many athletes come into camp with too much adipose tissue. They immediately begin on "the complex". This is a series of six exercises that are performed in succession with nominal weights. They include;
  • Slow Movement/High Pull
  • Muscle Snatch
  • Good Morning Exercise
  • Squat
  • Push Press
  • Bent Over Row

These are done for 6 repetitions, in succession. An athlete will do a series of these ballistic movements, such as a squat and a push press, and they'll then come back immediately and perform a Saigon Squat, which is nothing more than just a squatting down exercise. Some athletes may have to grab a supportive rack for balance, but this set of exercises helps to dramatically open the hips, to the point where the athlete can get down to the ground.

Also in this base phase of conditioning are the aerobic and anaerobic categories. Of the two, the anaerobic is far more important. There are four parts to this program. There will be different types of runs performed and integrated with a core of exercises that are ballistic in nature with static stretches of 10 second durations. Once these are performed, a 40 yard run, such as a step over drill, will be done, and on the way back, the athlete will perform a backward skip. Another series of exercises will be done, and then another 40 yard run, this time, a side slide, which is just a straight legged slide movement. As the athlete becomes more conditioned, the number of repetitions will be increased.

With these exercises, an athlete will create more flexibility as well as small fiber work that can't be gotten in the weight room. With this, stability is greatly improved, which is important for all athletes. The key is to work in short bouts with repetitive numbers. This significantly cuts down on the fat of an athlete while improving flexibility.

The Work Capacity phase of the pyramid system sometimes takes an athlete 12 weeks to complete before moving on to the Strength Phase. If an athlete cannot perform the necessary moves, stretches and exercises required at the initial phase, it would be counter productive to move them to the second level of strength training. Many of the athletes who hold out on contracts miss this critical phase of development and ultimately end up injured. With proper time, discipline and willingness, an athlete will quickly move up the ladder to the ultimate phase, which is Speed.


An athlete is like a balloon. The stronger, faster and sometimes bigger they can become, the more successful they are. Unfortunately, when you blow up a balloon, there is a point where the balloon breaks. The same applies to athletes. The key is to push the envelope without breaking the athlete. Do everything that can be done so that the athlete can tolerate the conditioning as well as the sport itself. And use successful techniques to do this.

Chiropractic is the leading profession capable of recognizing and correcting structural defects. Based on the protocol outlined in this article, any athlete is capable of making significant improvements with most structural defects.

When these benefits are coupled with a solid conditioning program, either by a strength coach or a knowledgeable chiropractor, all athletes will have the potential to reach new heights. For chiropractors to treat purely on a symptomatic level and establish no relationship with strength coaches nor provide conditioning information to an athlete is insufficient. This is truly the time for all sports minded chiropractors to become far more involved with all local teams and establish the protocol that will provide the benefits that will help all athletes. It's time to improve both communication and management with the athletic community.